肾衰方治疗不同原发病致CKD3～4期脾肾两虚湿浊血瘀证临床研究
发布时间：2019-04-26 20:23
【摘要】：目的:本文旨在观察肾衰方治疗不同原发病(高血压、糖尿病、慢性肾炎三种原发病)致慢性肾脏病(CKD)3~4期脾肾两虚湿浊血瘀证患者的临床疗效,探讨肾衰方对治疗不同原发病致慢性肾脏病的中医临床症状及实验室指标的影响,进一步指导中医临床实践。材料与方法:收集在2015年3月~2016年9月期间,辽宁中医药大学附属医院肾内科病房,入院治疗的慢性肾脏病(CKD)3~4期患者,依据本实验研究所制定的诊断、纳入及排除标准,共选取115例患者。依据原发病分为三组,均予基础内科治疗及肾衰方中药汤剂口服,疗程为2周。治疗结束后观察各组患者治疗前后的临床症状积分、肾脏功能相关指标,包括血清肌酐(Scr)、血清尿素氮(BUN)、内生肌酐清除率(Ccr)的变化情况,计算总有效率,比较三组临床疗效的差异,并横向比较肾衰方对不同原发病的疗效和影响。结果:1.三组患者临床疗效比较疾病疗效比较,治疗后三组患者的临床症状、体征均有所改善(P0.05),慢性肾炎组总有效率为81.82%,而高血压组总有效率为56.76%,糖尿病组总有效率为55.88%,以慢性肾炎组改善更为明显(P0.0167)。中医证候疗效比较,治疗后三组患者的临床症状均有所好转(P0.05),慢性肾炎组总有效率79.55%,高血压组总有效率54.05%,糖尿病组总有效率50.00%,以慢性肾炎组改善更为明显(P0.0167)。2.三组患者中医症状积分比较三组与治疗前相比较中医症状积分均有所降低(P0.05),差异具有统计学意义,提示三组治疗均有效。治疗前后三组间差异比较,高血压组与糖尿病组组间比较,P㧐0.05,差异无统计学意义,慢性肾炎组与其他两组组间比较,P0.05,差异具有统计学意义。3.三组患者肾脏功能相关指标水平比较三组治疗后均可降低Scr、BUN,增加Ccr,P0.05,提示差异具有统计学意义;而Scr、BUN降低幅度,Ccr上升幅度方面,慢性肾炎组明显高于高血压组与糖尿病组(P0.05)。结论:肾衰方对不同原发病(高血压、糖尿病、慢性肾炎三种原发病)致慢性肾脏病(CKD)3~4期脾肾两虚湿浊血瘀证的患者,可以有效缓解其临床症状、体征,改善肾脏功能,降低血清肌酐、血清尿素氮,提高内生肌酐清除率,尤其对慢性肾炎致慢性肾脏病更具意义。该方对临床具有指导意义,进而拓展其临床运用范围。
[Abstract]:Objective: to observe the clinical efficacy of Shenshuai recipe in treating chronic renal disease caused by different primary diseases (hypertension, diabetes and chronic glomerulonephritis) in (CKD) 3 / 4 stage of spleen-kidney deficiency and dampness-turbidity and blood stasis syndrome. To explore the effect of Shenshuai recipe on the clinical symptoms and laboratory indexes of chronic kidney disease caused by different primary diseases, and to further guide the clinical practice of traditional Chinese medicine. Materials and methods: from March 2015 to September 2016, the Department of Nephropathy, affiliated Hospital of Liaoning University of traditional Chinese Medicine, and hospitalized patients with chronic kidney disease (CKD) 3 / 4) were collected, according to the diagnosis, inclusion and exclusion criteria established by this laboratory research institute. 115 patients were selected. According to the primary disease, they were divided into three groups and were given basic medical treatment and Shenshuai decoction orally for 2 weeks. After treatment, the clinical symptom score, renal function related indexes, including the changes of serum creatinine (Scr), serum urea nitrogen (BUN), endogenous creatinine clearance rate (Ccr), and the total effective rate were observed before and after treatment, and the total effective rate was calculated. To compare the clinical curative effect of three groups, and to compare the curative effect and influence of Shenshuai recipe on different primary diseases. Results: 1. After treatment, the clinical symptoms and signs of the three groups were improved (P0.05). The total effective rate of chronic nephritis group was 88.82%, and the total effective rate of hypertension group was 56.76%. The total effective rate in the diabetic group was 55.88%, and the improvement was more obvious in the chronic nephritis group (P 0.0167). After treatment, the clinical symptoms of the three groups were improved (P0.05), the total effective rate of chronic nephrotic group was 79.55%, the total effective rate of hypertension group was 54.05%, and the total effective rate of diabetes group was 50.00%, the total effective rate of chronic nephritis group was 79.55%, the total effective rate of hypertension group was 54.05%. The improvement was more obvious in chronic glomerulonephritis group (P0.0167). TCM symptom score of three groups was lower than that of pre-treatment (P0.05), the difference was statistically significant, suggesting that the three groups were effective. Before and after treatment, there was no significant difference between hypertension group and diabetes group (P < 0.05), but there was no significant difference between chronic nephritis group and other two groups (P 0.05, P < 0.05). 3. There was a significant difference between hypertension group and diabetes group (P < 0.05). The levels of renal function related indexes in the three groups were significantly lower than those in the three groups after treatment. The increase of Scr,BUN, and Ccr,P0.05, in the three groups were significantly lower than those in the control group. On the other hand, the decrease of Scr,BUN and the increase of Ccr in chronic nephritis group were significantly higher than those in hypertension group and diabetic group (P0.05). Conclusion: Shenshuai recipe can effectively relieve clinical symptoms, signs and improve renal function in patients with chronic renal disease caused by different primary diseases (hypertension, diabetes mellitus, chronic glomerulonephritis) in (CKD) 3 / 4 stage of spleen-kidney deficiency and dampness-turbidity and blood stasis syndrome. Reducing serum creatinine, serum urea nitrogen and increasing endogenous creatinine clearance rate are especially significant for chronic renal disease induced by chronic nephrosis. This prescription has guiding significance to clinical practice, and then expand its clinical application range.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.5
本文编号：2466358
[Abstract]:Objective: to observe the clinical efficacy of Shenshuai recipe in treating chronic renal disease caused by different primary diseases (hypertension, diabetes and chronic glomerulonephritis) in (CKD) 3 / 4 stage of spleen-kidney deficiency and dampness-turbidity and blood stasis syndrome. To explore the effect of Shenshuai recipe on the clinical symptoms and laboratory indexes of chronic kidney disease caused by different primary diseases, and to further guide the clinical practice of traditional Chinese medicine. Materials and methods: from March 2015 to September 2016, the Department of Nephropathy, affiliated Hospital of Liaoning University of traditional Chinese Medicine, and hospitalized patients with chronic kidney disease (CKD) 3 / 4) were collected, according to the diagnosis, inclusion and exclusion criteria established by this laboratory research institute. 115 patients were selected. According to the primary disease, they were divided into three groups and were given basic medical treatment and Shenshuai decoction orally for 2 weeks. After treatment, the clinical symptom score, renal function related indexes, including the changes of serum creatinine (Scr), serum urea nitrogen (BUN), endogenous creatinine clearance rate (Ccr), and the total effective rate were observed before and after treatment, and the total effective rate was calculated. To compare the clinical curative effect of three groups, and to compare the curative effect and influence of Shenshuai recipe on different primary diseases. Results: 1. After treatment, the clinical symptoms and signs of the three groups were improved (P0.05). The total effective rate of chronic nephritis group was 88.82%, and the total effective rate of hypertension group was 56.76%. The total effective rate in the diabetic group was 55.88%, and the improvement was more obvious in the chronic nephritis group (P 0.0167). After treatment, the clinical symptoms of the three groups were improved (P0.05), the total effective rate of chronic nephrotic group was 79.55%, the total effective rate of hypertension group was 54.05%, and the total effective rate of diabetes group was 50.00%, the total effective rate of chronic nephritis group was 79.55%, the total effective rate of hypertension group was 54.05%. The improvement was more obvious in chronic glomerulonephritis group (P0.0167). TCM symptom score of three groups was lower than that of pre-treatment (P0.05), the difference was statistically significant, suggesting that the three groups were effective. Before and after treatment, there was no significant difference between hypertension group and diabetes group (P < 0.05), but there was no significant difference between chronic nephritis group and other two groups (P 0.05, P < 0.05). 3. There was a significant difference between hypertension group and diabetes group (P < 0.05). The levels of renal function related indexes in the three groups were significantly lower than those in the three groups after treatment. The increase of Scr,BUN, and Ccr,P0.05, in the three groups were significantly lower than those in the control group. On the other hand, the decrease of Scr,BUN and the increase of Ccr in chronic nephritis group were significantly higher than those in hypertension group and diabetic group (P0.05). Conclusion: Shenshuai recipe can effectively relieve clinical symptoms, signs and improve renal function in patients with chronic renal disease caused by different primary diseases (hypertension, diabetes mellitus, chronic glomerulonephritis) in (CKD) 3 / 4 stage of spleen-kidney deficiency and dampness-turbidity and blood stasis syndrome. Reducing serum creatinine, serum urea nitrogen and increasing endogenous creatinine clearance rate are especially significant for chronic renal disease induced by chronic nephrosis. This prescription has guiding significance to clinical practice, and then expand its clinical application range.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.5
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